Skip to main content
Log in

Geriatrische Aspekte bei Diabetes mellitus

Geriatric aspects for the management of Diabetes mellitus

  • leitlinien für die praxis
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Es besteht eine hohe Inzidenz an Diabetes mellitus Typ 2 bei Über-70-Jährigen in industrialisierten Ländern. Dieser Artikel enthält Empfehlungen für die Diagnose, die Prävention und die Therapieziele in der Behandlung des älteren diabetischen Patienten an Hand der aktuellen Evidenzlage.

Summary

There is a high incidence of Diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Rathmann W, Haastert B, Icks A, et al. High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia. 2003;46:182–9.

    CAS  Google Scholar 

  2. DECODE Study Group. Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care. 2003;26:61–9.

    Article  Google Scholar 

  3. Resnick HE, Harris MI, Brock DB, Harris TB. American Diabetes Association diabetes diagnostic criteria, advancing age, and cardiovascular disease risk profiles: results from the Third National Health and Nutrition Examination Survey. Diabetes Care. 2000;23:176–80.

    Article  PubMed  CAS  Google Scholar 

  4. Hauner H, Kurnaz AA, Haastert B, Groschopp C, Feldhoff KH. Undiagnosed diabetes mellitus and metabolic control assessed by HbA(1c) among residents of nursing homes. Exp Clin Endocrinol Diabetes. 2001;109:326–9.

    Article  PubMed  CAS  Google Scholar 

  5. American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care. 34(Suppl 1):11–61.

    Article  Google Scholar 

  6. Bethel MA, Sloan FA, Belsky D, Feinglos MN. Longitudinal incidence and prevalence of adverse outcomes of diabetes mellitus in elderly patients. Arch Intern Med. 2007;167:921–7.

    Article  PubMed  Google Scholar 

  7. Rosenthal MJ, Fajardo M, Gilmore S, Morley JE, Naliboff BD. Hospitalization and mortality of diabetes in older adults. A 3-year prospective study. Diabetes Care. 1998;21:231–5.

    Article  PubMed  CAS  Google Scholar 

  8. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  PubMed  CAS  Google Scholar 

  9. Jefferis BJ, Whincup PH, Lennon L, Wannamethee SG. Longitudinal associations between changes in physical activity and onset of type 2 diabetes in older British men: the influence of adiposity. Diabetes Care. 2012;35:1876–83.

    Article  PubMed  Google Scholar 

  10. Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364:1218–29.

    Article  PubMed  CAS  Google Scholar 

  11. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 34:1329–36.

  12. Tan HH, McAlpine RR, James P, et al. Diagnosis of type 2 diabetes at an older age: effect on mortality in men and women. Diabetes Care. 2004;27:2797–9.

    Article  PubMed  Google Scholar 

  13. Zeyfang A, Braun A. Guidelines “Diabetes mellitus in the elderly”. MMW Fortschr Med. 2009;151:33–5, 37.

    PubMed  CAS  Google Scholar 

  14. Siegmund T, Schumm-Draeger PM. Therapie mit oralen Antidiabetika und/oder Insulin im höheren Alter? Diabetologe. 2010;6:560–9.

  15. Bertoni AG, Krop JS, Anderson GF, Brancati FL. Diabetes-related morbidity and mortality in a national sample of U.S. elders. Diabetes Care. 2002;25:471–5.

    Article  PubMed  Google Scholar 

  16. Gregg EW, Beckles GL, Williamson DF, et al. Diabetes and physical disability among older U.S. adults. Diabetes Care. 2000;23:1272–7.

    Article  PubMed  CAS  Google Scholar 

  17. Krop JS, Powe NR, Weller WE, Shaffer TJ, Saudek CD, Anderson GF. Patterns of expenditures and use of services among older adults with diabetes. Implications for the transition to capitated managed care. Diabetes Care. 1998;21:747–52.

    Article  PubMed  CAS  Google Scholar 

  18. Abbatecola AM, Rizzo MR, Barbieri M, et al. Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics. Neurology. 2006;67:235–40.

    Article  PubMed  CAS  Google Scholar 

  19. Bremer JP, Jauch-Chara K, Hallschmid M, Schmid S, Schultes B. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32:1513–7.

    Article  PubMed  CAS  Google Scholar 

  20. Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr., Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301:1565–72.

    Article  PubMed  CAS  Google Scholar 

  21. Punthakee Z, Miller ME, Launer LJ, et al. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care. 2012;35:787–93.

    Article  PubMed  Google Scholar 

  22. Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.

    Article  PubMed  Google Scholar 

  23. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.

    Article  PubMed  CAS  Google Scholar 

  24. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  Google Scholar 

  25. Sinclair A, Morley JE, Rodriguez-Manas L, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc. 2012;13:497–502.

    Article  PubMed  Google Scholar 

  26. Schernthaner G, et al. Antihypertensive Therapie bei Diabetes mellitus – Leitlinie der österreichischen Diabetesgesellschaft. Wien Klin Wochenschrift. 2012 (In diesem ausgabe).

  27. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011–53.

    Google Scholar 

  28. Arauz-Pacheco C, Parrott MA, Raskin P. Hypertension management in adults with diabetes. Diabetes Care. 2004;27(Suppl 1):65–7.

    Article  Google Scholar 

  29. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623–30.

    Article  PubMed  CAS  Google Scholar 

  30. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22.

    Article  Google Scholar 

  31. Donnan PT, MacDonald TM, Morris AD. Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabet Med. 2002;19:279–84.

    Article  PubMed  CAS  Google Scholar 

  32. Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366:1279–89.

    Article  PubMed  CAS  Google Scholar 

  33. Schwartz SL. Treatment of elderly patients with type 2 diabetes mellitus: a systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitors. Am J Geriatr Pharmacother. 2010;8:405–18.

    Article  PubMed  CAS  Google Scholar 

  34. Barzilai N, Guo H, Mahoney EM, et al. Efficacy and tolerability of sitagliptin monotherapy in elderly patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Curr Med Res Opin. 2011;27:1049–58.

    Article  PubMed  CAS  Google Scholar 

  35. Stafford S, Elahi D, Meneilly GS. Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin in older adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2011;59:1148–9.

    Article  PubMed  Google Scholar 

  36. Barnett AH. The role of GLP-1 mimetics and basal insulin analogues in type 2 diabetes mellitus: guidance from studies of liraglutide. Diabetes Obes Metab. 2012;14:304–14.

    Article  PubMed  CAS  Google Scholar 

  37. Graefe-Mody U, Friedrich C, Port A, et al. Effect of renal impairment on the pharmacokinetics of the dipeptidyl peptidase-4 inhibitor linagliptin(*). Diabetes Obes Metab. 2011;13:939–46.

    Article  PubMed  CAS  Google Scholar 

  38. Braun AK, Kubiak T, Kuntsche J, et al. SGS: a structured treatment and teaching programme for older patients with diabetes mellitus—a prospective randomised controlled multi-centre trial. Age Ageing. 2009;38:390–6.

    Article  PubMed  Google Scholar 

  39. Zeyfang A. Practical aspects of diabetes care in the elderly. MMW Fortschr Med. 2009;151:40–2.

    PubMed  CAS  Google Scholar 

  40. Scherbaum WA KW, Hader C, Gräf-Gruss R. Für die DGG/ÖGGG „Praxis-Leitlinie: Diabetes im Alter.“ Eur J Geriatr. 2006;8:231–5.

    Google Scholar 

Download references

Interessenskonflikt

J. H. hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Forschungsunterstützungen und/oder Honorare erhalten: Eli Lilly, Novartis, Novo Nordisk, Pfizer, Servier. M. S. hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Forschungsunterstützungen und/oder Honorare erhalten: Abbott. M. L. hat von folgenden Unternehmen, die auch förderende Mitglieder der ÖDG sind, Honorare erhalten: Astra Zeneca, Bristol-Myers Squibb, Germania Pharmazeutika, GlaxoSmithKline Pharma, Eli Lilly, Medtronic, Merck Sharp&Dome, Novartis, Novo Nordisk, Pfizer, Sanofi-Aventis, Takeda. P. F. hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Forschungsunterstützungen und/oder Honorare erhalten: Abbott, Astra Zeneca, Bayer Health Care, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Germania Pharmazeutika, GlaxoSmithKline Pharma, Eli Lilly, Merck Serono, Merck Sharp&Dohme, Novartis, Novo Nordisk, Pfizer, Roche, sanofi-aventis, Servier, Takeda. Zusätzlich gebe ich an, dass für mich persönlich kein Interessenskonflikt vorliegt. Ich lege offen, dass ich in diesem Zeitraum von den genannten Firmen Honorare für Vorträge und Consulting erhalten habe, bzw. Fortbildungsunterstützung im Rahmen der (dienst)rechtlichen Rahmenbedingungen bezogen habe (Einladung zu Kongressen) bzw. Klinische Studien als PI mit einzelnen Firmen durchgeführt habe bzw. durchführe.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joakim Huber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huber, J., Smeikal, M., Lechleitner, M. et al. Geriatrische Aspekte bei Diabetes mellitus. Wien Klin Wochenschr 124 (Suppl 2), 74–78 (2012). https://doi.org/10.1007/s00508-012-0283-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-012-0283-1

Navigation